GP intervention call to tackle drop in asthma control

GPs are being encouraged to undertake ‘proactive review’ of asthmatic patients in line with the latest guidelines, as new research reveals declining health outcomes over the past decade.
 
The study, published in the Medical Journal of Australia, surveyed 5427 adults with asthma in 2021 comparing results against an earlier study in 2012 involving 2686 adults.
 
Results showed a ‘substantial worsening of key asthma indicators’ between 2012 and 2021, including poorer symptom control and higher urgent healthcare use.
 
Some 52% of participants were found to have ‘uncontrolled symptoms’ compared with 54% in 2012.
 
In 2021, 38% of participants required at least one urgent asthma-related visit to the GP, emergency department or hospital compared with 29% from the earlier study.
 
Quality of life was also worse in 2021, with asthma found to be interfering more with day-to-day activities and impacting more on health status (28% compared with 20.5%).
 
The new data from 2021 also showed that short-acting beta2-agonists (SABA) overuse was common, with 56% of adult SABA users obtaining three or more inhalers in the previous 12 months.
 
Medication use of any form of inhaled corticosteroid (ICS) remained steady at 60% across both surveys, however adherence was ‘worse’, with fewer participants taking ICS five days or more a week.
 
Only 13% of participants reported use of an anti-inflammatory reliever (combination ICS–formoterol), which is the preferred treatment strategy in the new 2025 Australian asthma guidelines.
 
The 2025 guidelines marked a shift in approach for asthma care, advising against prescribing or recommending treatment using only SABA to manage the condition in adults and adolescents.
 
It signalled a move away from the so-called blue puffers that have long been a feature of asthma treatment.
 
Researchers say their study highlights a need to ensure those guidelines are followed.
 
‘The findings raise serious concerns about asthma management in Australia but highlight major opportunities for improving outcomes if the new guidelines are widely implemented,’ they concluded.
 
While urgent healthcare use for asthma ‘rose substantially’, the proportion of patients reporting a non-urgent GP review for asthma in the previous year increased to about two-thirds in 2021.
 
This presents ‘opportunities for improvement, if the recent major changes in Australian asthma guidelines for adolescents and adults are widely implemented’, the authors wrote.
 
Chair of RACGP Specific Interests Respiratory Medicine, Dr Kerry Hancock, agrees the results emphasise the importance of implementing the new guidelines.
 
‘This is an enlightening study that reveals that we still have much to do to improve outcomes for Australians with asthma, and there are opportunities for GPs and their practice teams to contribute to this by proactive review of the asthma management of their patients,’ she told newsGP.
 
‘The recently updated Australian Asthma Handbook and its associated resources (quick reference guide, information sheets etc) provide clinicians with the tools to assist their patients avoid over reliance on SABA use and facilitate all patients with asthma, including those with mild asthma and/or intermittent symptoms, to take an ICS containing therapy.
 
‘This will improve the lives of people with asthma and reduce the need for emergency care and hospitalisation.’
 
Asthma is one of the most common chronic conditions in Australia, with a prevalence of 11% in adults and children – one of the highest globally.
 
The researchers said no obvious explanation emerged from the 2021 survey for the worsening in asthma outcomes, except for a further reduction in already low adherence.

However, they note increasing pressure on GPs ‘due to increased prevalence of chronic disease, workforce shortages and gaps in funding and infrastructure, and more patients are delaying care for chronic conditions’.
 
They also flagged that for implementation to succeed and asthma outcomes to improve, ‘system level issues’ also need to be urgently addressed, ‘particularly the current disparity in accessibility and cost between SABA inhalers and the safer and more effective combination ICS–formoterol options’.
 
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